Nigeria: Fighting cholera while working overseas

********* This article was originally published in World Of Irish Nursing**********

World of Irish Nursing March 2012 Working in Africa was very rewarding for Dublin nurse Laura Duggan who saw cholera patients return from the brink of death in just days

Swapping her role as an intensive care nurse at St Vincent’s Hospital in Dublin for an intense experience of a different kind was no easy feat for one brave Dubliner. Laura Duggan recently embarked on an emergency mission in northwestern Nigeria with Nobel Prize-winning humanitarian agency Médecins Sans Frontières (MSF), otherwise known as ‘Doctors Without Borders’.

“Volunteering overseas is something I’ve always wanted to do”, explained Laura, who was accepted onto the MSF register after she completed her diploma in tropical nursing in London. “I feel that I’m available, I have the skills and I’m interested in seeing how people live in other countries, so for me, it’s a case of ‘why not?’”

Assigned to the Emergency Response Unit over her four-month mission, Laura and her team responded to three outbreaks of cholera, a disease that can have a mortality rate as high as 50% if patients do not receive the correct treatment in time.

Getting stuck in

“It was very hands-on”, says Laura, who is currently on a leave of absence from her job in Dublin. “You would see a person almost dead, coming in with a non-detectable pulse. Immediately you’d have to get an IV line into them and give them large volumes of fluid. But within a few hours they would be sitting up and talking to you. The treatment is that quick and it’s very rewarding to see”.

“My role as an MSF nurse was to train and support the local health authorities to respond to cholera”, Laura continues. “The health workers there are very hardworking and doing the best they can with what they have, but generally there is no comparison between hospitals in Ireland and hospitals in this part of Nigeria where the cholera outbreaks are occurring.

“In Vincent ’s for example, I worked in ICU and each bed there has its own flat screen TV. In Nigeria, we often had no electricity, and we had to use torches at night just to see the patients. So to help the hospitals cope with the extra burden of the cholera outbreaks, we brought all the medical supplies needed and trained the staff up in the correct treatment protocols”.

Motorbikes and megaphones

Inside a cholera treatment centre in Nigeria

Inside a cholera treatment centre in Nigeria

Laura’s role extended beyond direct nursing to community awareness: “When our team arrived in a town, we’d hire town criers. These were basically guys on motorbikes. We’d give them a megaphone so they could go around telling people to boil their water before drinking it, and if they had symptoms of cholera to come to the hospital and be treated by our team free of charge.

“I was on the move a lot,” she said. “If we had 10 patients arriving into the hospital from a rural village, we’d hop in the jeep and go out to the village ourselves to see what the problem was. It could be that people were drinking from a polluted river. We’d work with the local government to solve the problem by installing oral rehydration points, which are a system of buckets and cups with the oral rehydration solution on tap; educating the community health workers; and giving medical supplies to the local dispensaries”.

Communication is key

Nigeria was an eye-opener for Laura in many ways. “Before I left Ireland, I really didn’t know what to expect. A lot of people were joking with me about Internet scams, but the people I met in Nigeria were very welcoming and very respectful. The kids were great fun and the patients were really, really appreciative”, she said.

“I learned how to communicate a few key health messages in the local language, such as ‘shay rua sousi, sousi’, which means ‘drink lots of water, frequently’. If I had any free time I’d march around the wards repeating this over and over. The patients would be rolling around the place laughing at me, but they got the gist of what I was trying to say and they’d all take a drink of water”.

Work-life balance in 40°C
Despite the hard work and long days, Laura found time to relax in the evenings. Games of speed scrabble, darts and sing-songs with the other team members helped to alleviate any stress brought about by the hectic workload in a blisteringly hot, desert climate. What she missed most, however, was being able to go for a walk on her own due to the security precautions that MSF put in place.

“I felt safe at all times”, she said. “My family wasn’t worried because I’ve done a lot of travelling before. They were very reassured because I was complaining about the strictness of the security rules. They knew I couldn’t get into too much trouble!”

Having spent a relaxing few weeks at home, Laura is now eager to return to ‘the field’ for another mission with MSF.

“I really enjoyed the whole experience. I met great staff and patients”, she says. “The thing with cholera is that it’s very quickly rewarding because people transform from being on the brink to being healthy again in just a matter of days.

We treated about 8,000 patients and we got the mortality rate to below 2% in all three responses. You could see a decrease in the number of patients arriving in on death’s door as our community messages and awareness started to work”.

Water and sanitation officer, Zakira, with Laura outside a cholera treatment centre

Water and sanitation officer, Zakira, with Laura outside a cholera treatment centre

Asked if she’d recommend volunteering with MSF to others, Laura said: “It’s hard work, you have a lot of responsibility, but it’s well worth it”.